56. The UK&I National Neuromodulation Registry: deprivation does not affect outcome after spinal cord stimulation

Abstract

Background: Health-related inequality between most and least affluent areas is known to adversely affect many outcomes in the UK. Years lived without disability are lower and prevalence of chronic pain is higher in more deprived areas. Additionally, access to specialist chronic pain services is lower in deprived areas. The index of multiple deprivation (IMD) is a composite measure of deprivation (encompassing several measures including crime and income), and ranks population areas across the country (1 most deprived to 32,844 most affluent - also stratified in deciles). We aim to see if there is inequality of outcome or rate of follow up between the most and least affluent regions in the UK after SCS for chronic pain. Method(s): QoL (EuroQoL 5-dimension 5-level) and demographic data were extracted from the NNR, for patients treated between February 2018 and July 2023 in 27 UK centres. Those without recorded baseline EQ5D or postcode were excluded. IMD were derived from the Ministry of Housing, Communities, and Local Government website. Result(s): There were 2204 patients that had available IMD. There was no preponderance of frequency of IMD decile (fig 1). There were 1527 patients that had paired pre- and post-operative follow up data. Baseline QoL was significantly higher in the most affluent decile compared with the most deprived (0.328 vs. 0.210, p=0.0002, Welch's two sample t-test). The mean utility index change after surgery was similar between the most and least affluent IMD deciles (decile 1: mean utility improvement of 0.220, n=166 vs. decile 10: 0.197, n=197; p=0.55, Welch's two sample t-test). The proportion of patients lost to follow up and with post-operative outcome data was similar in the most and least affluent IMD deciles (166 followed up, 71 not followed up in decile 1 vs. 123 followed up, 50 not followed up in decile 10; p=0.66, Fisher's exact test). There was a small but significant positive correlation seen between pre-operative utility index and IMD rank (Spearman's rank correlation rho = +0.11, p<0.0001, fig 2). There was no correlation observed between IMD rank and change in utility after surgery (Spearman's rank correlation rho = -0.02, p=0.49, fig 3). Conclusion(s): SCS significantly improves QoL for patients equally regardless of socioeconomic status. Patients undergoing SCS exhibit inequality of baseline QoL related to IMD. While this does not address the potential inequality of access to chronic pain services, it shows that when patients do undergo SCS, their outcomes and loss to follow up can be expected to be similar regardless of deprivation category. Copyright © 2025